CVA Flashcards
risk factors for stroke
- age
- previous TIA/stroke
- hypertension
- hypercholesterolaemia
- atrial fibrillation
- heart disease (ischaemia, valvular, carotid artery_
- smoking and alcohol
Characteristics of TACI
- higher cerebral dysfunction
- hemianopia
- ipsilateral motor or sensory deficit
characteristics of PACI
2 of the following
- higher cerebral dysfunction
- hemianopia
- ipsilateral motor or sensory deficit
characteristics of POCI
One of
- cerebellar or brainstem symptoms (ataxia, dysdiadokinesis)
- loss of consciousness
- isolated homonymous hemianopia
characteristics of LACI
either
- pure motor stroke
- pure sensory stoke
Management of acute stroke
- ABCD
- straight to CT to exclude haemorrhage
- if within 4.5hrs and no contraindications give IV thrombolysis
- if >4.5hrs 300mg Aspirin
- if haemorrhae benefit from surgical decompression and BP lowering
what are the other features of stroke managed in a stroke unit
- swallow assessment within 4hrs
- normalise blood sugars
- iv paracetomal to reduce temp
- oxygen if hypoxic
- image carotids once stable
VTE prophylaxis in acute stroke?
s/c heparin is contraindicated acutely in stroke
TEDs are contraindicated
ensure pt is hydrated and avoid smoking
risk stratification in TIA
Age >60
BP > 140/90
Clinical features- 1 point for dysphasia and 2 for hemiparesis
Duration of sx 1 point if >10mins, 2 points if >60mins
D2- diabetes
secondary prevention after TIA/stroke
- clopidogrel 75mg (first line)
- Aspirin 75 mg - can give both if severe stenosis otherwise its second line
- atorvastatin
- antihypertensives- perindopril or indapamide
- control vascular risk factors
when is carotid endartectomy undetaken?
used if >50% internal carotid artery stenosis on the symptomatic side
risk stratification in AF
CHADSVASC score
- congestive heart failure (1)
- Hypertension >140/90 (1)
- age >75 (2) 65-74 (1)
- diabetes (1)
- stroke/tia/VTE (2)
- vascular disease (1)
- sex female (1)
management of high risk AF patients
- anticoagulation with warfarin (target INR 2-3)
- if contraindicated aspirin 75-300mg
signs of an impaired swallow
dribbling facial weakness coughing/choking after swallow food regurgitation recurrent chest infections
what is first line management of impaired swallow
- NBM
- temporary NG tube
- await SLT assessment
